Families Coping with Underage Drinking

The purpose of this paper is examining the impact of underage drinking on families and how they cope with this issue from a family systems perspective. In addition, this paper aims at identifying implications for the nursing practice, the role of the advance practice nurse, and evidenced-based nursing research as it pertains to underage drinking, alcoholism and family systems in this underserved population.

Alcoholism is a major problem in many communities and this, unfortunately, includes young adults under the age of 21, teens and children. Just like any other addictive drug, alcohol is a substance used and abused by many. This research focuses on alcohol use in excess and how it often leads to the disease of alcoholism, particularly among the youth. Alcoholism is not a benign condition; it is a disease that is chronic and progressive and a person suffering from this disease has little or no control over his or her drinking problems (Mayo Clinic, 2012). This is due to the fact that both physical and physiological factors are associated with this disease. Alcoholics are compelled to drink, and this is so even when they show signs of physical, mental and emotional illness and pain. Additionally, an alcoholic often loses important things in his or her life such as family and friends, as well as jobs, assets, dignity and hope.

Certain factors are associated with the risk of someone developing alcoholism, and this is particularly true with underage individuals. These factors include alcohol use for dealing with stress and peer pressure, as well as the need to conform and seek entertainment and enjoyment. As it relates to underage drinking, families are left to cope with this issue and it often takes its toll on the family. In addition, it is important to note that alcohol use and abuse is not necessarily an activity of an alcoholic. Many drinkers, including underage drinkers, use and abuse alcohol regularly without being officially diagnosed with alcoholism.

Analysis of Underserved Population


Alcohol use and abuse by drinkers under the age of 21 is a major public health concern. Alcohol is in the same category as any other drug used and abused in society. Unfortunately, this pertains to those who are underage, as well as it does those who are not. According to the Centers for Disease Control and Prevention (CDC), alcohol is the top used and abused substance in America, among the youth. This causes many illnesses, disabilities and fatalities each year. The World Health Organization (WHO) finds alcohol consumption responsible for a significant amount of injuries and hospital emergency visits annually. The CDC reports that, in 2010, about 189,000 people under 21 were taken to emergency rooms for injuries or health conditions related to alcohol consumption. Alcohol-related injuries include falls, drownings, traffic accidents and many other injuries. Studies show that alcohol consumption was the cause of over 16 percent of deaths and over 13 percent of disabilities, around the world in 2000. Excessive alcohol consumption leads to alcohol intoxication which affects brain functioning related to vision, judgment, reaction time ability, and cognitive ability. In addition, people who are intoxicated are often aggressive and may inadvertently put themselves in harm’s way. They may also take risks they otherwise would not take, such as provoking drama situations with other people or by creating trouble-prone circumstances (Ye & Cherpitel, 2009).

As it relates to underage drinkers, the CDC (2012) reports that over 4,700 youth are killed as a result of some type of alcohol-related incident each year. The report also states that children as young as 12 years old admit to being drinkers, and those between the ages of 12 and 20 consume 11% of all alcohol consumed in the United States. This is mostly in the form of binge drinking which, according to Mann (2010), is defined by having five or more alcoholic beverages in one day or on one occasion, at least one time per month. This type of alcohol abuse is a possible factor that leads to alcoholism. The CDC states that out of the 11% of alcohol drinkers between ages 12 and 20, binge drinking is associated with 90% of them, and drinkers who are underage drink more per occasion than adult drinkers.

Description of the Population

The population highlighted in this research is underage alcohol users who are also abusers of alcohol. Drinking is a part of pop culture for the youth and is the number one drug used and abused among American teenagers. Statistics show that 51% of children in the 8th grade, 71% of teenagers in the 10th grade, and at least 80% of teenagers in the 12th grade report being alcohol drinkers. These are alarming numbers. As well, approximately 30% of all high school students surveyed report binge drinking within the previous month (Eaton, et al., 2004). In addition, it is suggested that the youth use alcohol in response to social and peer pressures, as well as personal and environmental factors. It is also significant to note that alcohol accessibility is a contributing factor to underage drinking. Many youth report their homes offer them easy access to alcoholic beverages because their parents have liquor stashes or open bars at home (Eaton, et al., 2004).

Many children in rural areas report their reasons for drinking as non-closeness to parents, lack of a firm religious upbringing in the home, group drinking opportunities, reduction of stress, and trying to fit in with peers. Moreover, parental and community norms, attitudes and views toward drinking have a significant effect on whether or not young people start drinking. A recent study shows that children as young as 9 years old report having tried alcohol at some point (de Haan & Boljevac, 2009). This is an unfortunate fact and various interventions are needed to combat this issue. It is additionally concerning that children in the study reported actually being drunk at least once in their lives. This is very early onset alcohol abuse that can lead to physical, mental, emotional, and financial problems later in these children’s lives. Another alarming result from research findings state that children who drink get the alcohol from their parents or from friends, rather than from buying it themselves. Clearly, this means that more emphasis needs to be placed on educating adults about the dangers and mishaps of underage drinking.

Related Health and Social Problems of Underage Drinkers

It is reported, by a 2011 risk behavior survey, that high school student survey participants admitted to drinking some alcohol within a 30-day timeframe, binge drinking, drinking and driving, or riding with someone who drank. The problems with this are widespread for the students and include poor grades, social issues, sickness, stunted physical and sexual development, suicidal or homicidal tendencies, vehicle crashes and other accidents, loss of memory, drug abuse, and alcohol poisoning (CDC, 2012). Other negative outcomes of underage drinking include accidental deaths, criminal behavior, irresponsible sexual activity that leads to teenage pregnancy and the contraction of sexually transmitted diseases (Eaton, et al., 2004).

Review of Literature

Clinical Discussion

Koutakis, N., Stattin, H., & Kerr, M. (2008, October). Reducing youth alcohol drinking through a parent-targeted intervention: the Örebro Prevention Program. Addiction, 103(10), 1629-37.

Purpose: This is an exploratory study that examines a youth drinking prevention program for youth between the ages of 13 and 16 from the inner city, public housing, and small towns. Prevention programs were geared to family influences.  The significance of this literature was evaluating urban and rural areas from various communities to include the inner city, public housing and small towns. Also, the purpose included showing participation rates for the study and parental attitudes toward underage drinking.

Theoretical Concepts: The structural approach, in this article, as it relates to family therapy for underage drinking issues involved the participation of the parents of junior and high schools students in grades 7 to 9. This included assessing parental roles in the context of families dealing with stress caused by underage drinking. These roles include communicating strict attitudes against underage drinking and encouraging their children in being involved in activities that are organized and supervised by adults. This speaks to the importance of family structure when dealing with stressful life events, and this is integral when making adjusments to deal with challenges of their children’s drinking behaviors.

Clinical Analysis: Study analyses showed success in implementing organized activities with the incorporation of parents’ attitudes about underage drinkers. This was in response to study findings that showed that many parents were strict initially, but became more lenient toward underage drinking as time went on during the 3-year study. The analyses also showed that underage drinking increased over time as did deliquency.

Limitations of the Study: The research limitations of this study include the assessment of only individual changes instead of school-wide changes related to conditions and treatment of the students. Also, many of the more lenient parents dropped out of the study early. Another limitation was the fact that the youth’s level of intoxication was subjective, so there was no real way of accurately ranking their drunkeness.

de Haan, L., & Boljevac, T. (2009, February). Alcohol Use Among Rural Middle School

            Students: Adolescents, Parents, Teachers, and Community Leaders’ Perceptions.

Journal of School Health, 79(2), 58-92.

Purpose: This is a quantitative study that focuses on attitudes and behaviors toward underage drinking, particularly in middle school students, in rural communities in the Upper Midwest. This study distinguishes factors between adolescents who drink alcohol and those who do not. Also, the integral roles and attitudes among community leaders, parents and teachers and whether or not these differences contribute to underage drinking in these communities is analyzed.

Theoretical Concepts: The structural approach used for this study included administering a nationwide household drug abuse survey among four states in the Upper Midwest. Participant selection was determined by census data. This also includes the role and influence of adults (parents, community leaders, and teachers) in the lives of adolescent drinkers, particularly when it related to binge drinking. Community controls, family involvement, perceptions of peer drinking, financial strain, and perceptions of adult drinking were all theoretically examined as influencing factors in underage drinking.

Clinical Analysis: After the data analysis was completed, findings showed those adolescents reporting not ever trying alcohol were 53% of the participants and 27% of these said they had tried alcohol before but did not drink any in the previous month. Our of the total sample, 10% of the participants reported that they did drinkiin the previous month, and 10% of the total sample reported being intoxicated before. Results also showed that the participants reported past alcohol use of 0 to 30 alcoholic beverages, but on average they reported consuming 5 drinks in the previous month. Findings included attitudes toward underage drinking and analysis results showed that parents were less concerned that underage drinking was a problem in their community, but community leaders and school officials had a different perspective and believed it to be a problem. As well, adolescent perception of underage drinking proved to be more accurate.

Limitations of the Study: This research study was somewhat limited due to the fact that most of the participants were Caucasian. Therefore, there needs to be further research to better represent other ethnic groups to reach more definitive results. In addition, the study points out that more focused attention needs to be placed on educating parents so that they may head off early onset adolescent drinking. This is due, in part, because the participants most commonly reported that their access to alcohol was through their parents. In addition, implications of the study include the importance for more community support initiatives to meet this growing challenge.

Research Discussion

Eaton, D. K., Forthofer, M. S., Zapata, L. B., Brown, K. R., Bryant, C. A., Reynolds, S. T., et al.

(2004, March). Factors Related to Alcohol Use among 6th through 10th Graders:

            The Sarasota County Demonstration Project. Journal of School Health, 74(3).

Purpose: This study focuses on reducing alcohol use among 6th through 10th grade children in Sarasota County. It examines alcohol iniatition among this group as a target behavior and significant factors associated with alcohol use in this group. Community-based intervention is also a target strategy for this purpose.

Research Methods: Methods used for this study included in-depth interviews and focus groups to survey a representative sample of the age group population of 6th through 10th graders, as well as 9th and 10th grade students, to determine possible trends in alcohol use throughout middle school and into high school. The sampling frame included 10 middle schools in Sarasota County, Florida categorized as exception and alternative. The target sampling number of surveys completed was 400 per grade level, with was about 30% of the total student population. The survey method used stratified, random sampling within the schools. Total school participation was 16, with 113 classes of a total of 2,407 student participants surveyed. Exclusion amounted to 14% of the completed surveys (328), due to missing data and truth issues. This left a total of 2,004 useable surveys, or 83% of the survey sample, for data analysis.

Results: Survey findings reported on the demographics of drinking prevalence, whether or not the children ever used alcohol before, reports of recent alcohol use and binge drinking. The demographics of the survey participants included 51% males, 82% Caucasians, and 11% Hispanics. Findings show that 66% of the females in the study and 68% of the males reported ever using alcohol at all in their lives. In addition, 49% of the males and 48% of females reported recent alcohol use and both girls and boys reported episodes of binge drinking in the previous year, 39% and 33%, respectively. These statistics are relatively close as it pertains to gender.

Limitations of the Study: Possible significant limitations were due to variables pertaining to social norms about alcohol use, such as attitudes toward alcohol use barriers (such as cost) or possible benefits (such as fitting in), and other perceptions by the youth with respect to drinking. Therefore, drawing conclusions of why youth drink is speculative and is a basis for limitations in the study.

Implications: The study points out that youth intervention programs are essential to addressing the problem of underage drinking. Also the influence of parents and other adults in the lives of these youth have a bearing on the perceptions about social norms pertaining to alcohol use, and this influences their decision-making when it comes to drinking. The study also points out that social marketing initiatives can play a signficant role in prevention.

Fromme, K., Wetherill, R. R., & Neal, D. J. (2010, July/August). Turning 21 and the Associated Changes in Drinking and Driving After Drinking Among College Students. Journal of American College Health, 59(1), 21-27, 7.

Purpose: This study examines the incidence of young people drinking and driving before the age of 21 and after turning 21. This is specifically studied in college students. According to the research, 70% of college students reported using alcohol each month. Out of these same college students, 44% of them reported binge drinking episodes within the previous two weeks. As it relates to drinking and driving, the study reports that over 2 million college students admit driving after drinking which results in more than 1,800 annual deaths.

Research Methods: Methods for research evaulated the effects of alcohol on behavior as well as legal access to it. The research also addresses issues concerning turning 21 years old and what happens then with college students and drinking. Research study participant eligibility included unmarried, first-time college students who ages ranged from 17 to 19. The sample included 2,247 participants and only 1,817 were included in the analyses, due to non-participation or missing data. Research data was collected via web-based surveys. Questionnaires were also used to obtain informaiton about typical alcohol use and frequency. In addition, a risky events survey was administered to collect information about drinking and driving.

Results: Research findings that when students make the transition from being underage to adulthood at the age of 21, their risk levels on speific factors change. For example, 21st birthday celebrations tend to involve heavy alcohol drinking since 21 is the legal age to drink.

Limitations of the Study: This research study had limitations that included only the analysis of students at alarge public university, differences in regional 21st birthday celebrations that may include alcohol, ethnic and gender limitations of mostly Caucasian females, and self-reporting accuracy

Implications: It is recommended that more education geared toward prevention should be focused on this age group as a target group for age-specific programs for intervention.

Ramisetty-Mikler, S., Caetano, R., Goebert, D., & Nishimura, S. (2004, January). Ethnic variation in drinking, drug use, and sexual behavior among adolescents in Hawaii. Journal of School Health, 74(1), 16-22.

Purpose: This study examines drinking and drug use among adolescents, and how this related to increased risks of unsafe sexual practices. The research focused on high school students in Hawaii from three ethinic grous to include Asians (58%), Caucasians (39%), and Native Hawaiians other Pacific Islanders (23%). The purpose also included estimating the prevalence of alcohol use among culturally diverse populations, according to age, gender, and ethnicity.

Research Methods: Methods for research included a sample design made up of a representative sample of high school students from the 9th through the 12th grades in Hawaii public schools. Eligibilty included all students with parental permission. The data was collected by an in-class multiple-choice survey questionnaire about health-risk behaviors, including use of alcohol, tobacco, alcohol and other drugs, unsafe sex, eating habits, physical inactivity. Questionaire responses were weighted and adjusted for nonresponsiveness and variations in sampling procedures.

Results: The study results were reported in percentages weighted with unweighted sample sizes. For sexual behavior and drinking, findings showed ethnicity as a significant factor in tendencies, according to those who had ever had sexual intercourse, the age of first encounter, and how many sexual partners experienced. This was true for males and females. In addition, the research showed that Caucasians were more likely to practice safe sex or to have initiated sex by the age of 15 or have had multiple partners in their lives. As it relates to alcohol use, about 25% of Caucasian and Native Hawaiian females reported the using alcohol or drugs with sex. However, males were more likely to do this. Findings showed no ethnic differences of alcohol or drugs use with sex for males. Findings also showed that students who used alcohol or drugs were more likely to engage in sexual activity.

Limitations of the Study: This research study had limitations that included low response rates due to reluctancy of the participants to disclose sexual or alcohol or drug use behaviors, and no parental permission for some students. Other limitations include data only representative of public schools and the fact that all people in the age group were not measured. Also, long-term effects were not able to be determined.

Implications: It is determined that alcohol and drug use, as well as unsafe sexual practices, are dependent on self-control and positive life skills. Therefore, more education and awarness among parents and adolescents is important, particularly as it pertains to the detrimental effects of this type of behavior. It is also significant to note that, based on the research, early onset for these behaviors is related to unhealthy and risky behaviors among adolescents. Recommendations are teaching them the importance of abstinence, so that they may delay substance use and sexual activity. In addition, the need for intervention programs focusing on abstinence and parental behaviors, as well as cultural aspects concerning substance use is highlighted.

Implications for Evidenced-based Family System Nursing Practices

It is important that proper assessments are completed for monitoring children and adolescents to prevent underage drinking. In addition, monitoring risky behaviors, levels of knowledge about the effects of underage drinking, financial concerns, and psychosocial issues such as family stress and coping skills are an integral part of effective nursing practices. The role of the advanced nurse in making adequate assessments about the needs of the family coping with underage drinking through family counseling and developing effective communication strategies for healthy coping skills is important. Those in the nursing profession are also in a position to influence policy changes in schools and communities which support health education and healthy activities in order to prevent underage drinking. Moreover, as stated above, this is also something that should be encouraged by other significant role models in the children’s lives, such as teachers, parents, people in the community, and those in leadership positions in administration (de Haan & Boljevac, 2009).


Trends in underage alcohol use and abuse remain a significant public health problem, in which society is affected, as well as families and communities. Viable solutions to this problem include advocating for increased awareness about alcoholism, as well as and more education for adolescents and teenagers to teach them that drinking is serious and not something they should perceive as cool. Life-threatening consequences can result from using and abusing alcohol. Additionally, specific risks associated with the onset of underage drinking needs to be addressed such as teen and adolescent exposure and access to alcohol. This includes intervention initiatives by family, school and church officials, community leaders, and society as a whole. It is also important to note that prevention is preferable, to offset the onset of early drinking. This can be done through many avenues, particularly those initiated by respected youth role models. Also, as it pertains to youth who are past the prevention stage and are using or abusing alcohol, continued support is necessary, such as that found with counseling and medical interventions.


CDC. (2012, October 29). Fact Sheets – Underage Drinking. Retrieved from Centers for Disease Control and Prevention:

de Haan, L., & Boljevac, T. (2009, February). Alcohol Use Among Rural Middle School Students: Adolescents, Parents, Teachers, and Community Leaders’ Perceptions. Journal of School Health, 79(2), 58-92.

Eaton, D. K., Forthofer, M. S., Zapata, L. B., Brown, K. R., Bryant, C. A., Reynolds, S. T., et al. (2004, March). Factors Related to Alcohol Use among 6th through 10th Graders: The Sarasota County Demonstration Project. Journal of School Health, 74(3).

Fromme, K., Wetherill, R. R., & Neal, D. J. (2010, July/August). Turning 21 and the Associated Changes in Drinking and Driving After Drinking Among College Students. Journal of American College Health, 59(1), 21-27, 7.

Koutakis, N., Stattin, H., & Kerr, M. (2008, October). Reducing youth alcohol drinking through a parent-targeted intervention: the Örebro Prevention Program. Addiction, 103(10),


Mann, D. (2010, July 20). More Americans drinking (alcohol). CNN Health.

Mayo Clinic. (2012, August 9). Alcoholism. Retrieved from The Mayo Clinic:

Ramisetty-Mikler, S., Caetano, R., Goebert, D., & Nishimura, S. (2004, January). Ethnic variation in drinking, drug use, and sexual behavior among adolescents in Hawaii. Journal of School Health, 74(1), 16-22.

Ye, Y., & Cherpitel, C. J. (2009). Risk of Injury Associated with Alcohol and Alcohol-related Injury. Emeryville, CA: Alcohol Research Group.